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Diagnostic performance of 68Ga-PSMA-11 PET/MRI in biochemical recurrent prostate cancer after radical prostatectomy and prediction nomogram. 68Ga-PSMA-11 PET/MRI对前列腺根治术后生化复发性前列腺癌的诊断价值及预测图
IF 2.3 3区 医学
Urologic Oncology-seminars and Original Investigations Pub Date : 2025-09-04 DOI: 10.1016/j.urolonc.2025.08.010
Uğuray Aydos, Selahattin Barış Küçükali, Erdem Balcı, Edanur Tunçay İbiş, Seda Gülbahar Ateş, Ümit Özgür Akdemir, Lütfiye Özlem Atay
{"title":"Diagnostic performance of <sup>68</sup>Ga-PSMA-11 PET/MRI in biochemical recurrent prostate cancer after radical prostatectomy and prediction nomogram.","authors":"Uğuray Aydos, Selahattin Barış Küçükali, Erdem Balcı, Edanur Tunçay İbiş, Seda Gülbahar Ateş, Ümit Özgür Akdemir, Lütfiye Özlem Atay","doi":"10.1016/j.urolonc.2025.08.010","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.08.010","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the diagnostic performance of <sup>68</sup>Ga-PSMA-11 PET/MRI in prostate cancer (PC) with biochemical recurrence (BCR) after radical prostatectomy (RP). It was also aimed to develop a nomogram to predict PET/MRI positivity.</p><p><strong>Methods: </strong>The data of 140 PC patients who underwent <sup>68</sup>Ga-PSMA-11 PET/MRI for BCR after RP were retrospectively analyzed. PSA, ISUP Gleason grades (GG), androgen deprivation therapy (ADT), and PSA doubling time (PSAdt) were recorded. Regression analysis was performed to determine the predictive factors for PET/MRI positivity. Regression coefficients were used to develop a nomogram in early BCR group (PSA < 1.0 ng/ml) and 100 bootstrap resamples were used for internal validation. Receiver operating characteristic analysis was used to evaluate the performance of model. Decision curve analysis (DCA) was implemented to quantify the clinical net benefit of nomogram.</p><p><strong>Results: </strong>The overall detection rate was 75%. Detection rate was 100% in patients with PSA ≥ 1.0 ng/ml. In patients with early BCR (PSA < 1.0 ng/ml; n = 94), the detection rate was 62.8%. Prediction nomogram demonstrated a bootstrap corrected accuracy of 83%. In DCA, with a nomogram derived probability threshold ≥60%, the use of the nomogram would result in a net benefit gain of 36%.</p><p><strong>Conclusions: </strong>If PSA level is ≥1.0 ng/ml in PC patients with BCR after RP, <sup>68</sup>Ga-PSMA-11 PET/MRI has very high detection rates. In patients with PSA < 1.0 ng/ml, PSAdt seems to be the strongest predictive factor in the prediction of imaging positivity. Our nomogram provided good accuracy and it seems as an important tool in the best use of PET/MRI.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Peritoneal recurrence following nephrectomy for localized renal cancer: A multicenter European real-world analysis of incidence, pattern and treatment (PEMET study-UroCCR 124). 局部肾癌切除后腹膜复发:一项欧洲多中心的发病率、模式和治疗分析(PEMET研究- uroccr 124)。
IF 2.3 3区 医学
Urologic Oncology-seminars and Original Investigations Pub Date : 2025-09-04 DOI: 10.1016/j.urolonc.2025.08.005
Caroline Pettenati, Jean-Christophe Bernhard, Zine-Eddine Khene, Umberto Capitanio, Giacomo Musso, Laurence Albiges, Larissa Rainho, Gaëlle Margue, Thibault Waeckel, Gregory Verhoest, Lucas Bento, Nicolas Doumerc, Louis Surlemont, Yann Neuzillet, Thierry Lebret, Niels Graafland, Saeed Dabestani, Axel Bex, Morgan Rouprêt, Karim Bensalah, Pierre Bigot
{"title":"Peritoneal recurrence following nephrectomy for localized renal cancer: A multicenter European real-world analysis of incidence, pattern and treatment (PEMET study-UroCCR 124).","authors":"Caroline Pettenati, Jean-Christophe Bernhard, Zine-Eddine Khene, Umberto Capitanio, Giacomo Musso, Laurence Albiges, Larissa Rainho, Gaëlle Margue, Thibault Waeckel, Gregory Verhoest, Lucas Bento, Nicolas Doumerc, Louis Surlemont, Yann Neuzillet, Thierry Lebret, Niels Graafland, Saeed Dabestani, Axel Bex, Morgan Rouprêt, Karim Bensalah, Pierre Bigot","doi":"10.1016/j.urolonc.2025.08.005","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.08.005","url":null,"abstract":"<p><strong>Background: </strong>Peritoneal recurrence (PREC) following nephrectomy for localized renal cancer (RCC) is rare. Our objective was to report a multicenter analysis of PREC to analyze incidence, treatment, survival and risk factors.</p><p><strong>Methods: </strong>Between 1987 and 2023, patients with PREC following radical or partial nephrectomy (PN) for localized RCC across ten European institutions (UroCCR, NKI, IRCCS, Foch and Gustave Roussy centers) were included. PREC patterns were defined as isolated PREC (iPREC) and PREC associated with other metastatic sites (mPREC). The main objective was to evaluate PREC incidence (n PREC / n RCC surgeries). Secondary objectives were to assess PREC treatments, patients survival and risk factors associated with iPREC as compared to mPREC.</p><p><strong>Results: </strong>We included 117 patients with PREC, including 35 iPREC (30%) and 82 mPREC (70%). PREC incidence was 0.88%. Compared to mPREC, iPREC was significantly associated with PN (OR 4.1, 95% CI [1.7-9.5], P= 0.001), minimally invasive surgery (MIS) (OR 3.3, 95% CI [1.3-8.2], P= 0.007), and lower Leibovich risk scores (OR 4.6, 95% CI [1.9-11.0], P= 0.001). In multivariable analysis, Leibovich score remained significant (OR 3.3, 95% CI [1.2-8.8], P= 0.016). Treatment was mainly systemic (66.7%). Surgical treatment was performed in 11 iPREC cases, with 10 patients remaining progression-free at a median follow-up of 54 months. Overall survival was significantly better in iPREC group (P= 0.007).</p><p><strong>Conclusions: </strong>PREC incidence was below 1%. Our results suggest 2 distinct mechanisms. One involves local spread, potentially favored by MIS and PN, while the other corresponds to a metastatic dissemination driven by tumor aggressiveness. iPREC appears to have better prognosis as compared to mPREC and be effectively treated with surgery.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Agreement between transurethral resection of bladder tumor and radical cystectomy pathology in patients with bladder cancer subtype histology: A retrospective cohort study. 膀胱癌亚型组织学患者经尿道膀胱肿瘤切除术与根治性膀胱切除术病理的一致性:一项回顾性队列研究。
IF 2.3 3区 医学
Urologic Oncology-seminars and Original Investigations Pub Date : 2025-09-02 DOI: 10.1016/j.urolonc.2025.07.024
Dimitra Rafailia Bakaloudi, Elizabeth L Koehne, Jenna M Voutsinas, Leonidas Ν Diamantopoulos, Dimitrios Makrakis, Petros Grivas, Lawrence D True, Maria S Tretiakova, Funda Vakar-Lopez, Sarah P Psutka, Sarah K Holt, John L Gore, Daniel W Lin, George R Schade, Yaw A Nyame, Andrew C Hsieh, Todd Yezefski, Jessica E Hawley, Michael T Schweizer, Heather H Cheng, Evan Y Yu, R Bruce Montgomery, Qian Vicky Wu, Jonathan L Wright
{"title":"Agreement between transurethral resection of bladder tumor and radical cystectomy pathology in patients with bladder cancer subtype histology: A retrospective cohort study.","authors":"Dimitra Rafailia Bakaloudi, Elizabeth L Koehne, Jenna M Voutsinas, Leonidas Ν Diamantopoulos, Dimitrios Makrakis, Petros Grivas, Lawrence D True, Maria S Tretiakova, Funda Vakar-Lopez, Sarah P Psutka, Sarah K Holt, John L Gore, Daniel W Lin, George R Schade, Yaw A Nyame, Andrew C Hsieh, Todd Yezefski, Jessica E Hawley, Michael T Schweizer, Heather H Cheng, Evan Y Yu, R Bruce Montgomery, Qian Vicky Wu, Jonathan L Wright","doi":"10.1016/j.urolonc.2025.07.024","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.07.024","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Transurethral Resection of Bladder Tumor (TURBT) is a diagnostic staging procedure for bladder cancer (BC). Its pathologic interpretation may be limited by cautery artifact, lack of spatial orientation of tumor specimens, inter-pathologist variance in identifying subtypes, and sampling bias. Accurately identifying subtype histology (SH) on TURBT is critical for clinical decisions. We compared the agreement between TURBT and radical cystectomy (RC) pathology in patients with SH BC.</p><p><strong>Methods: </strong>We examined TURBT and RC pathology of patients who underwent RC at our institution. We included patients with pure SH and mixed histologies in either TURBT or RC specimens. Cohen's kappa coefficient was used to determine the degree of agreement between TURBT and RC.</p><p><strong>Results: </strong>From 1135 RC performed, 650 (57%) patients had SH in either TURBT or RC; 225 patients were (y)pT0 at the time of RC and 36 patients had rare histologies, leaving 389 patients for analysis. 172 (44%) patients had an exact match between TURBT and RC. We found a high level of agreement between TURBT and RC in pure non-UC histology (kappa range: 0.82-0.98). In contrast, we found substantial (sarcomatoid; kappa 0.70), moderate (squamous, glandular, plasmacytoid, small cell/neuroendocrine; kappa range: 0.42-0.55) and fair (micropapillary; kappa 0.38) concordance between TURBT and RC in patients with UC mixed with SH.</p><p><strong>Conclusions: </strong>We found variable levels of agreement of SH detection between TURBT and RC. Agreement was high in pure non-UC histology. Further, we found that NAT, completeness of TURBT, and >50% SH at TURBT are associated with the persistence of SH at RC. Future efforts are needed to develop reproducible diagnostic tools for accurate characterization of SH in UC.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Proposed tripartite classification of T1 renal cell carcinoma: Comparison with current binary system. 提出的T1肾细胞癌三段式分类:与目前二元分类的比较。
IF 2.3 3区 医学
Urologic Oncology-seminars and Original Investigations Pub Date : 2025-09-02 DOI: 10.1016/j.urolonc.2025.07.030
Margaret F Meagher, Giacomo Musso, Viraj Master, Hajime Tanaka, Umberto Capitanio, Allesandro Larcher, Mai Dabbas, Dattatraya Patil, Wei Chen, Dhruv Puri, Benjamin H Baker, Shamsunnahar Imtiaz, Cesare Saitta, Shohei Fukuda, Masaki Kobayashi, Andrea Salonia, Alberto Briganti, Yasuhisa Fujii, Francesco Montorsi, Ithaar H Derweesh
{"title":"Proposed tripartite classification of T1 renal cell carcinoma: Comparison with current binary system.","authors":"Margaret F Meagher, Giacomo Musso, Viraj Master, Hajime Tanaka, Umberto Capitanio, Allesandro Larcher, Mai Dabbas, Dattatraya Patil, Wei Chen, Dhruv Puri, Benjamin H Baker, Shamsunnahar Imtiaz, Cesare Saitta, Shohei Fukuda, Masaki Kobayashi, Andrea Salonia, Alberto Briganti, Yasuhisa Fujii, Francesco Montorsi, Ithaar H Derweesh","doi":"10.1016/j.urolonc.2025.07.030","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.07.030","url":null,"abstract":"<p><strong>Objective: </strong>Outcomes of stage 1 renal cell carcinoma (RCC) are heterogeneous and vary widely. We sought to investigate whether tripartite reclassification of current binary T1 RCC would lead to more rational consolidation of similar outcomes that may improve predictive ability.</p><p><strong>Methods: </strong>We performed a retrospective multicenter analysis of patients undergoing radical (RN) or partial nephrectomy (PN) for clinical T1N0M0 RCC. The cohort was divided into tumor size ≤3 cm, >3 cm or ≤5 cm, and >5 cm or ≤7 cm. Primary outcome was cancer-specific mortality/cancer-specific survival (CSM/CSS). Secondary outcomes were all-cause mortality/overall survival (ACM/OS) and recurrence/recurrence-free survival (recurrence/RFS). Multivariable analysis (MVA) was used to elucidate predictive factors for CSM, ACM, and recurrence. Kaplan-Meier Analysis (KMA) analyzed 10-year CSS, OS, and RFS. AUC/ROC analysis compared predictive capability of proposed tripartite reclassification of T1 defined as proposed-T1a (≤3 cm), T1b (>3 and ≤5 cm), and pT1c (>5 and ≤7 cm) vs. current binary T1a (≤4 cm) and T1b (>4 and ≤7 cm).</p><p><strong>Results: </strong>2,989 patients were analyzed (median follow-up 60 months). Increasing age (HR = 1.05, P < 0.001), proposed-T1c (vs. proposed-T1a referent [HR = 2.15, P = 0.008]), radical nephrectomy (HR 1.65, P = 0.023), and high-grade (HR = 2.44, P < 0.001) were associated with worsened CSM. Comparing proposed-T1a, T1b, and T1c, KMA revealed significantly worsened: 10-year OS with larger tumor size: (81% vs. 80% vs. 63%, respectively, P < 0.001) and 10-year CSS with larger tumor size (93% vs. 91% vs. 81%, respectively, P < 0.001). AUC analysis revealed greater predictive power for proposed-T1a, T1b, and T1c vs. current T1-RCC binary classification for OS (0.567 vs. 0.556) and CSS (0.643 vs. 0.599).</p><p><strong>Conclusion: </strong>Proposed-Tripartite subclassification of T1 RCC into T1a, T1b, and T1c groups corresponds to distinctive populations whose biological potential aligns more closely and may enhance risk stratification, refine pretreatment counseling and postoperative follow-up compared to protocols based on current binary T1 classification.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Stimulated Raman histology as a novel method for rapid pathologic examination of unprocessed, fresh testicular biopsies to determine seminoma. 刺激拉曼组织学作为一种新的方法,快速病理检查未经处理,新鲜睾丸活检,以确定精原细胞瘤。
IF 2.3 3区 医学
Urologic Oncology-seminars and Original Investigations Pub Date : 2025-09-02 DOI: 10.1016/j.urolonc.2025.08.008
Philipp Maisch, Gamal A Wakileh, Annika Beck, Miles P Mannas, Cornelia Horsch, Benjamin Mayer, Florian Khalid, Christian Bolenz, Michael Mühlberger
{"title":"Stimulated Raman histology as a novel method for rapid pathologic examination of unprocessed, fresh testicular biopsies to determine seminoma.","authors":"Philipp Maisch, Gamal A Wakileh, Annika Beck, Miles P Mannas, Cornelia Horsch, Benjamin Mayer, Florian Khalid, Christian Bolenz, Michael Mühlberger","doi":"10.1016/j.urolonc.2025.08.008","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.08.008","url":null,"abstract":"<p><strong>Background: </strong>Stimulated Raman histology (SRH) is a novel microscopic technique allowing real-time, label free, high-resolution microscopic images of unprocessed, unsectioned tissue. Tissue samples are imaged in the operating room using a mobile SRH microscope. Due to SRH's pseudocoloring, the images appear like conventional H&E staining. Compared to standard histopathologic analysis, formalin fixation, staining and level cutting can be omitted holding potential to decrease the time for diagnosis.</p><p><strong>Objective: </strong>The aim of this prospective feasibility study was to evaluate SRH in the diagnosis of seminoma.</p><p><strong>Methods: </strong>Patients with sonographic suspicion of testicular cancer, who underwent surgical exposure of the testis, were included in this study. A small biopsy of the suspicious lesion was separated ex vivo and scanned with an SRH microscope (NIO Laser Imaging System, Invenio Imaging Inc.). Three pathologists were tested on a 40-sample set, including benign and malignant images. We assessed combined accuracy, sensitivity and specificity and concordance (Cohen's Kappa and Fleiss Kappa) for inter-rater reliability.</p><p><strong>Results: </strong>With the use of SRH the combined accuracy in identifying malignancy was 90%, with an individual pathologist sensitivity range from 79 to 97%. The combined accuracy in identifying benign tissue was 94.4%, with an individual pathologist specificity range from 83 to 100%. Cohen's Kappa for inter-rater reliability had a range from 0.342 to 0.918, which was classified as weak to almost perfect. The scanning time was less than 180 seconds for all tissue samples.</p><p><strong>Conclusion: </strong>Through this first-in-human feasibility study we were able to show that SRH is a reliable and rapid point of care-technique to produce high-resolution images of seminoma, which can be accurately interpreted by pathologists. After further evaluation for all testicular germ cell tumors, SRH may have an impact on clinical decision-making during interventions for testicular cancer.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evaluation of intraoperative blood pressure and intrinsic tumor features as predictors of pseudoaneurysm formation after partial nephrectomy: A case-control study. 评估术中血压和内在肿瘤特征作为部分肾切除术后假性动脉瘤形成的预测因素:一项病例对照研究。
IF 2.3 3区 医学
Urologic Oncology-seminars and Original Investigations Pub Date : 2025-09-02 DOI: 10.1016/j.urolonc.2025.08.003
Harsha Kaul, Mitchell M Huang, Austin P Drysch, Joseph D Nicolas, Ridwan Alam, Nicole Handa, Ashley E Ross, Kent T Perry, Hiten D Patel
{"title":"Evaluation of intraoperative blood pressure and intrinsic tumor features as predictors of pseudoaneurysm formation after partial nephrectomy: A case-control study.","authors":"Harsha Kaul, Mitchell M Huang, Austin P Drysch, Joseph D Nicolas, Ridwan Alam, Nicole Handa, Ashley E Ross, Kent T Perry, Hiten D Patel","doi":"10.1016/j.urolonc.2025.08.003","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.08.003","url":null,"abstract":"<p><strong>Introduction: </strong>Renal artery pseudoaneurysm (RAP) is a life-threatening complication of partial nephrectomy (PN) with reported rates of 1% to 2%. No studies have reported on the association between intraoperative blood pressure (BP) and RAP.</p><p><strong>Methods: </strong>We identified all PN patients in our system between 2010 and 2024 and identified those with RAP (cases). We performed 4:1 propensity score matching to establish a control group. We compared maximum intraoperative systolic (SBP) and mean arterial blood pressure (MAP) between the groups and assessed the RAP formation rate. Analysis was performed using t-test, Fisher's exact test, and logistic regression.</p><p><strong>Results: </strong>Among 1,400 PNs, 31 patients (2.2%) experienced RAP (2.6% open vs. 2.2% robotic/laparoscopic, P = 0.6). Our study cohort included 155 patients-31 RAP and 124 control. Median time to RAP presentation was 11.5 days and 20 patients (65%) presented with hematuria. There was no significant difference in ischemia time (RAP: median 28.5 minutes vs. control: 25, P = 0.09), tumor complexity (overall: 7% high complexity, P = 0.3), or maximum intraoperative BP (overall: median SBP 173 mm Hg, P = 0.3; MAP 126 mm Hg, P= 0.3). In multivariable models adjusting for tumor complexity, size, and ischemia time, maximum intraoperative MAP (OR: 1.00, 95% CI: 0.99-1.01) and SBP (OR: 1.00, 95% CI: 0.99-1.01) were not associated with RAP formation; tumor size was associated with RAP (per +1 cm OR: 1.07, 95% CI: 1.01-1.14, P = 0.04).</p><p><strong>Conclusions: </strong>Greater tumor size, but not intraoperative BP, was associated with RAP formation. RAP rates in the robotic era are consistent with historical minimally invasive rates, while the open PN rate may be higher than previously reported.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Automated electronic medical record abstraction algorithm for radical prostatectomy outcomes. 根治性前列腺切除术结果的自动电子病历提取算法。
IF 2.3 3区 医学
Urologic Oncology-seminars and Original Investigations Pub Date : 2025-08-29 DOI: 10.1016/j.urolonc.2025.07.028
Maximilian J Rabil, Michael Jalfon, Peter Palencia, Dylan Heckscher, Victoria Kong, Aleksandra Golos, Rhys Richmond, Adam Chess, Isaac Y Kim, Michael S Leapman, Jaime A Cavallo
{"title":"Automated electronic medical record abstraction algorithm for radical prostatectomy outcomes.","authors":"Maximilian J Rabil, Michael Jalfon, Peter Palencia, Dylan Heckscher, Victoria Kong, Aleksandra Golos, Rhys Richmond, Adam Chess, Isaac Y Kim, Michael S Leapman, Jaime A Cavallo","doi":"10.1016/j.urolonc.2025.07.028","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.07.028","url":null,"abstract":"<p><strong>Objective: </strong>Variation in outcomes following radical prostatectomy and inclusion of prostate cancer surgery metrics in hospital ratings signal need for procedure-specific quality improvement (QI) efforts. We hypothesized that a novel electronic medical record (EMR)-based, automated algorithm-driven algorithm for surgical outcomes and quality metrics following robot-assisted laparoscopic radical prostatectomy (RALP) would demonstrate >90% sensitivity and specificity and significant inter-rater reliability (IRR) with National Surgical Quality Improvement Program (NSQIP) abstraction.</p><p><strong>Study design: </strong>We developed an algorithm to automatically abstract RALP outcomes and quality metrics retrospectively from the EMR. Pathology results were abstracted through text extraction; surgical outcomes were abstracted using ICD-10 codes, CPT codes, and EMR data variables. Sensitivity, specificity, and IRR between the algorithm and NSQIP-abstraction were assessed using Cohen's kappa with statistical significance set P < 0.05.</p><p><strong>Results: </strong>Total of 927 cases were mutually tracked. IRR was highest for mortality (k = 1.00) and lowest for dialysis and ureteral obstruction (k = 0.00). IRR was fair for: sepsis (k = 0.28), renal insufficiency (k = 0.32), and prolonged NGT/NPO (k = 0.39); moderate: UTI (k = 0.50) and stage (k = 0.53); substantial: surgical margins (k = 0.94), urine leak (k = 0.60), C-Diff (k = 0.67), pneumonia (k = 0.80). Sensitivity of the algorithm was > 90% for all mutually tracked outcomes except rectal injury (0%) and specificity was >97%.</p><p><strong>Conclusion: </strong>This novel algorithm for RALP outcomes matches or exceeds sensitivity and specificity of institutional NSQIP abstraction for all but 1 variable. Substantial agreement between the algorithm and NSQIP supports automated extraction of outcome metrics as an acceptable replacement for trained abstractors, and broader application provides opportunities to facilitate and reduce cost of outcomes and quality metric benchmarking.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Disparities in radiation treatment modality for prostate cancer. 前列腺癌放射治疗方式的差异。
IF 2.3 3区 医学
Urologic Oncology-seminars and Original Investigations Pub Date : 2025-08-29 DOI: 10.1016/j.urolonc.2025.07.033
Mitchell Alameddine, Shan Wu, Oluwaseun Orikogbo, Danielle Sharbaugh, Jonathan G Yabes, Daisy Obiora, Michael G Stencel, Benjamin J Davies, Lindsay M Sabik, Bruce L Jacobs
{"title":"Disparities in radiation treatment modality for prostate cancer.","authors":"Mitchell Alameddine, Shan Wu, Oluwaseun Orikogbo, Danielle Sharbaugh, Jonathan G Yabes, Daisy Obiora, Michael G Stencel, Benjamin J Davies, Lindsay M Sabik, Bruce L Jacobs","doi":"10.1016/j.urolonc.2025.07.033","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.07.033","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Stereotactic Body Radiation Therapy (SBRT) and Intensity Modulated Radiation Therapy (IMRT) are 2 common radiation treatment options used for prostate cancer therapy. SBRT has increased in use over the past decade. Factors associated with the uptake of this relatively novel therapy in prostate cancer patients are poorly understood. We attempted to characterize the choice of radiation therapy to help elucidate factors contributing to different treatment decisions.</p><p><strong>Methods: </strong>We studied 1,624 prostate cancer patients diagnosed between 2008 and 2017 in the SEER-Medicare dataset who were treated with SBRT or IMRT at networks offering SBRT. Our analysis focused on White or Black patients with localized prostate cancer. We analyzed patient demographics and compared median times from diagnosis to treatment using the Wilcoxon rank-sum test.</p><p><strong>Results: </strong>We identified clinical and demographic factors associated with SBRT use compared to IMRT. On multivariable logistic regression, Black race was associated with decreased odds of receiving SBRT compared to White race (OR: 0.4; 95% CI: 0.2-0.7). Hispanic compared to non-Hispanic ethnicity was associated with decreased odds of receiving SBRT (OR: 0.4; 95% CI: 0.2-0.9). Patients living in a county with a population less than 250,000 people were more likely to receive SBRT compared to patients living in populous counties (OR: 3.6; 95% CI: 1.7-7.7).</p><p><strong>Conclusions: </strong>Among patients from the SEER-Medicare dataset from 2008 to 2017 treated with radiation for clinically localized prostate cancer, disparities exist in the choice of treatment modality. Understanding differences in treatment patterns is an important area to guide intervention as SBRT becomes available nationwide.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Morbidity and mortality of salvage radical prostatectomy for prostate cancer: An analysis of the National surgical quality improvement program targeted prostatectomy database. 前列腺癌根治性前列腺切除术的发病率和死亡率:国家外科质量改进计划前列腺切除术数据库的分析。
IF 2.3 3区 医学
Urologic Oncology-seminars and Original Investigations Pub Date : 2025-08-29 DOI: 10.1016/j.urolonc.2025.07.019
Vatsala Mundra, Renil Sinu Titus, Eusebio Luna, Jiaqiong Xu, Carlos Riveros, Sanjana Ranganathan, Brian Miles, Dharam Kaushik, Christopher J D Wallis, Raj Satkunasivam
{"title":"Morbidity and mortality of salvage radical prostatectomy for prostate cancer: An analysis of the National surgical quality improvement program targeted prostatectomy database.","authors":"Vatsala Mundra, Renil Sinu Titus, Eusebio Luna, Jiaqiong Xu, Carlos Riveros, Sanjana Ranganathan, Brian Miles, Dharam Kaushik, Christopher J D Wallis, Raj Satkunasivam","doi":"10.1016/j.urolonc.2025.07.019","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.07.019","url":null,"abstract":"<p><strong>Introduction/background: </strong>For men with local recurrence of prostate cancer following radiotherapy, salvage radical prostatectomy (SRP) may be considered. However, SRP is associated with increased risk of surgical complications and patient selection is critical. To quantify this contemporary risk and identify predictive factors, we performed a retrospective cohort study utilizing the NSQIP targeted radical prostatectomy (RP) dataset.</p><p><strong>Methods: </strong>We identified adult patients undergoing robotic-assisted RP from 2019 to 2022 using the NSQIP database. The primary outcome was the rates of procedure-specific outcomes such as rectal injury, urinary leak or fistula, gastrointestinal (GI) leak/injury, prolonged postoperative nil per os (NPO) or nasogastric tube (NGT) use, and development of lymphoceles. Secondary outcomes included major postoperative outcomes. RP and SRP groups were balanced using propensity score matching.</p><p><strong>Results: </strong>Among 27,280 patients, SRP was associated with an increased risk of urinary leak or fistula (OR 3.94, 95% CI 1.85-8.39), GI injury (OR 1.80, 95% CI 1.09-2.98) and prolonged postoperative NPO or NG tube use (OR 5.15, 95% CI 2.24-11.83). SRP was associated with higher surgical site infections (SSI) (OR 3.17, 95% CI 1.60-6.30) and unplanned readmission (OR 2.43, 95% CI 1.33-4.44). Subgroup analysis identified an increased risk of urinary leak associated with SRP in those with a BMI >25 and age ≥65.</p><p><strong>Conclusion: </strong>SRP was associated with a 3-fold risk of SSI, 3-fold risk of leak/fistula and a 2-fold risk of unplanned readmission. Obese and elderly patients were more likely to experience urinary leak. These data can be used to optimize patients and select those who will benefit from SRP.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Outcomes of endoscopic management for upper tract urothelial carcinoma: A multi-center international cohort analysis. 内镜治疗上尿路上皮癌的结果:一项多中心国际队列分析。
IF 2.3 3区 医学
Urologic Oncology-seminars and Original Investigations Pub Date : 2025-08-25 DOI: 10.1016/j.urolonc.2025.07.015
Jaime O Herrera-Caceres, Marian Wettstein, Surena F Matin, Craig Labbate, Aaron Potretzke, Rodrigo Rodriguez, Nirmish Singla, Maximilian Pallauf, William Huang, Shavy Nagpal, Nir Kleinmann, Asaf Shvero, Alexander Small, Benjamin Green, Jennifer Linehan, Jane Choe, Ojas Shah, Arun Rai, Hristos Kaimakliotis, Isamu Tachibana, David Canes, Aaron Perecman, Jay D Raman
{"title":"Outcomes of endoscopic management for upper tract urothelial carcinoma: A multi-center international cohort analysis.","authors":"Jaime O Herrera-Caceres, Marian Wettstein, Surena F Matin, Craig Labbate, Aaron Potretzke, Rodrigo Rodriguez, Nirmish Singla, Maximilian Pallauf, William Huang, Shavy Nagpal, Nir Kleinmann, Asaf Shvero, Alexander Small, Benjamin Green, Jennifer Linehan, Jane Choe, Ojas Shah, Arun Rai, Hristos Kaimakliotis, Isamu Tachibana, David Canes, Aaron Perecman, Jay D Raman","doi":"10.1016/j.urolonc.2025.07.015","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.07.015","url":null,"abstract":"<p><strong>Introduction: </strong>Upper tract urothelial carcinoma (UTUC) is a rare and aggressive malignancy with significant morbidity, often requiring radical nephroureterectomy (RNU) as the standard of care. Endoscopic ablation has emerged as a kidney-sparing alternative, particularly for low-risk UTUC. Given the rarity of UTUC, generating high-quality evidence for treatment strategies remains challenging. This study presents a large, multi-institutional analysis of outcomes following primary endoscopic ablation for UTUC.</p><p><strong>Methods: </strong>A retrospective analysis of 432 patients across 11 institutions who underwent first-time endoscopic treatment for UTUC with curative intent between December 2003 and January 2023 was performed. Baseline demographics, tumor characteristics, and procedural details were collected. Recurrence was categorized as ipsilateral, distant, or bladder recurrence, with overall survival (OS) as the primary outcome. Univariate and multivariate Cox regression models were used to identify predictors of recurrence and survival.</p><p><strong>Results: </strong>At a median follow-up of 21 months, ipsilateral recurrence occurred in 232 patients (54%), while 55 (13%) developed distant metastases. The OS rate was 86%, with 29 patients (6.7%) dying within the first 12 months. On univariate analysis, the presence of a tumor not involving the renal pelvis (HR 0.71, P = 0.04) and use of a ureteral access sheath (UAS) (HR 0.65, P = 0.03) were associated with lower ipsilateral recurrence rates. On multivariate analysis, only UAS use remained significant (HR 0.39, P < 0.01). High-grade tumors were significantly associated with poorer OS (HR 3.59, P < 0.01).</p><p><strong>Conclusions: </strong>Endoscopic ablation is a feasible kidney-sparing alternative for UTUC. Ipsilateral recurrence rate is approximately 50% with over 10% of patients developing metastatic disease. UAS use may reduce UTUC recurrence risk.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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